Application Form - Consulate General of Japan

2013 JAPANESE AMERICAN LEADERSHIP DELEGATION TO JAPAN
13 TH DELEGATION
APPLICATION FORM
Individuals selected must be able to travel to Japan from March 8 – 16, 2013 and
attend a mandatory orientation in Los Angeles on January 25 - 26, 2013.
Deadline for application submission: October 31, 2012.
Your resume may be used for the following information and can be supplemented with
an attachment. However, all requested information must be provided.
Name
Address – Business and Home (specify preferred mailing address)
Telephone – Business, Home, Cell Phone
E-mail Address
Occupation
Date of Birth
Place of Birth (Specify your Japanese American generational background, e.g., sansei,
yonsei.)
Prefecture(s) in Japan where your ancestors originated
Educational Background (Specify name of university or institution, degree, specify major,
year of graduation, honors, etc.)
Professional Background (Current employment - Specify name of company/organization, title,
years of employment and other relevant information; brief listing of prior employment).
Professional Affiliations & Leadership Positions
Community/Volunteer Affiliations & Leadership Positions
Prior Visits to Japan if applicable (Specify year, length of stay and purpose of visit)
Personal Interests (Hobbies, cultural/social interests, etc.)
References (Two): (Preferably individuals who are knowledgeable about your experience
in U.S.-Japan relations and/or your professional/community/volunteer experience).
Letters of recommendation are not required.
Please provide a brief response to the following questions:
Attach separate sheet – no more than TWO pages double-spaced.
1. Why do you wish to participate in this program
2. Briefly describe any prior experience you have had in U.S.-Japan relations.
3. How did you learn about this program
Please send all information by e-mail, fax, or mail to Yoshiro Tasaka at Consulate General
of Japan in San Francisco (sa2cg@cgjsf.org (email), 415-974-3660 (fax), 50 Fremont Street
Suite 2300, San Francisco, CA). Residents of Washington, D.C. should send information to

the Embassy of Japan. A second copy should be sent to Bryan Takeda
(btakeda@usjapancouncil.org ) by e-mail
to***********************************************************************.
For more information contact:
San Francisco Consulate
Yoshiro Tasaka, sa2cg@cgjsf.org, (415) 356-2441
50 Fremont Street, Suite 2300
San Francisco, California, 94105
Los Angeles Consulate
Ms. Jennifer Usyak, j_usyak@la-cgjapan.org, (213) 617-6700 x166 or
Consul Toshio Odagiri, t_odagiri@la-cgjapan.org, (213) 617-6700
US-Japan Council
Mr. Bryan Takeda, btakeda@usjapancouncil.org